P785: CURRENT CARDIOVASCULAR DISEASE RISK PREDICTION MODELS ARE NOT APPLICABLE IN MDS PATIENTS: PRELIMINARY RESULTS OF A PROSPECTIVE OBSERVATIONAL SINGLE-CENTRE COHORT STUDY
Authors: C. Misidou, E. Gkolia, C. Kymparidou, V. Papadopoulos, M. Papoutselis, K. Liapis, I. Mitroulis, G. Vrachiolias, S. P. Deftereos, D. Stakos, I. Kotsianidis
Journal: HemaSphere (2022)

Background: Cardiovascular disease (CVD) is a leading cause of death in lower-risk Myelodysplastic syndrome (LR-MDS) patients and a shared pathobiology between MDS and CVD has been postulated. However, current evidence emanates only from retrospective cohorts suffering from crucial limitations. Aims: Prospective annotation can overcome these limitations and delineate the role of MDS as an independent CVD risk factor. For this reason we conducted a prospective observational single-centre cohort study in LR-MDS patients. Methods: Patients underwent thorough evaluation for CVD every 6 months. Cerebrovascular, peripheral and coronary vascular beds were assessed for atherosclerosis by ultrasound and coronary artery calcium (CAC), respectively. Cardiac structure and function was assessed by echocardiography. Multi-Ethnic Study of Atherosclerosis (MESA), Framingham (FRS) risk scores and serum markers of myocardial injury (Serum high-sensitivity troponin T, hsTnT), stress (N-terminal pro–B-type natriuretic peptide, NT-proBNP), and systemic inflammation (high-sensitivity C-reactive protein, hsCRP) were also estimated at each visit. Chi-square, Wilcoxon signed-ranks tests and Pearson’s correlation coefficient were used as appropriate. Multiple linear regression was applied for modeling the relationship between a dependent and one or more independent variables. The level of statistical significance was set to P=0.05. Results: Table 1 presents baseline characteristics of 24 patients included so far. There were no correlations of CAC, MESA and FRS with MDS subtype and IPSS-R risk category when adjusting for MDS-CI, preexisting CVD, age, sex, and transfusion dependence. In sharp contrast to the general population (Okwuosa, TM et al. JACC 2011), CAC score was not associated with FRS and was disproportionately increased in low and very low FRS risk patients (Figure 1). Likewise, the number of affected vascular beds (AVB) did not correlate with FRS (Figure 2), further suggesting that the current CVD risk prediction tools are inaccurate in MDS and arguing for an intrinsic tendency of MDS towards CVD development. In 9 out of 24 patients a second evaluation at 6 months was completed. All 9 patients increased significantly CAC (p=0.004) and MESA (p=0.003) scores at 6 months, while 5/9 patients also increased the number of AVB. The average increase of CAC score (189.77 +/-212.89) was markedly higher than expected in the age-matched general population (Budoff, MJ et al. JACC 2013) and was not associated with FRS at baseline, while it was also independent of MDS subtype and IPSS-R risk category after adjusting for MDS-CI, preexisting CVD, age, sex, and transfusion dependence. Finally, baseline NT-proBNP levels correlated strongly with CAC score (Figure 3) in line with numerous evidence showing that NT-proBNP can serve as a predictor of CVD risk in both MDS and non-MDS individuals. Image:Summary/Conclusion: To our knowledge this is the first study in LR-MDS patients assessing longitudinally all critical parameters and providing objective measurements of subclinical atherosclerosis in all vascular beds. Our preliminary results indicate that the established CVD prediction models do not operate in LR-MDS patients and reinforce the notion that MDS represents an independent factor for CVD development. Accurate assessment of CVD risk and prompt detection of subclinical cardiovascular disease in MDS patients will assist clinical decisions on the introduction of intensive monitoring and preventive use of CVD-specific interventions in these individuals.